Malignant melanoma of the female genital system: A report of 48 patients and review of the literature

Ariel, Irving M.

doi:10.1002/jso.2930160411

Cited by 90 publications

(45 citation statements)

References 31 publications

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“…5 The biological behavior of primary vulvar and extragenital cutaneous malignant melanoma appeared to be comparable. 13,16 However, some studies 1,3,20 have shown that the overall prognosis for patients with vulvar melanoma is generally poor, compared with cases of cutaneous melanoma and invasive vulvar carcinoma, with a higher tendency towards regional and distant recurrence.…”

Section: Discussionmentioning

confidence: 98%

“…5 Consequently, most reports are limited by consisting only of small retrospective numbers of cases over a long period of time. Over recent decades, few studies reviewing more than 40 patients have been published.…”

Section: Discussionmentioning

confidence: 99%

“…4 Historically, radical vulvectomy and bilateral inguinal lymph node dissection were the recommended treatment for malignant vulvar melanoma, regardless of lesion size, thickness or depth of invasion. 5,6 However, over the last few years, there have been some reports suggesting that acceptable survival has been achieved through less radical procedures performed on early disease. [6][7][8][9][10][11][12][13][14] In the literature, it is suggested that the clinical and postoperative staging is the most significant predictor of survival.…”

Section: Introductionmentioning

confidence: 99%

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Vulvar melanoma: report on eleven cases and review of the literature

et al. 2010

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Context and objeCtive: Vulvar melanoma is a rare disease. We describe the experience of a single institution and review the literature.design and setting: Retrospective study at the Department of Gynecology, Hospital do Cancer A. C. Camargo.Methods: Eleven patients with vulvar melanoma attended between January 1987 and December 2006 were reviewed regarding clinicopathological characteristics, surgical therapy and follow-up. Results:The initial symptoms were vulvar lesions, pruritus, pain and bleeding. The median age was 64.8 years. The median depth of invasion was 3.08 mm. The staging ranged from IB to IIIC (American Joint Committee on Cancer, 2002). All the patients underwent vulvectomy. Two patients did not undergo primary elective lymphadenectomy. Bilateral inguinal lymphadenectomy was performed on five patients, and one had unilateral inguinal lymphadenectomy. Sentinel lymph node investigation was performed on three patients. Five patients had locoregional recurrence. Prolonged survival was only achieved in the absence of lymph node involvement. The median follow-up was 56 months. The median disease-free survival was 15 months and the median overall survival was 29 months. ConClusions:The prognosis for patients with vulvar melanoma is generally poor, with a high tendency towards regional and distant recurrence. Depth of invasion and lymph node involvement are the most important prognostic factors. In most cases, resection of the lesion with adequate margins may replace vulvectomy. Elective inguinal femoral lymphadenectomy remains the standard lymph node staging procedure. Sentinel lymph node investigation is feasible and should be performed by a multidisciplinary team with experience of this method. RESUMOContexto e objetivo: Melanoma de vulva é uma doença rara. Descrevemos a experiência de uma instituição e revisamos a literatura. ConClusões: O prognóstico das pacientes com melanoma de vulva geralmente é ruim, com tendência a recorrência regional e à distância. A profundidade de invasão e envolvimento linfonodal são os principais fatores prognósticos. Na maioria dos casos a ressecção da lesão com margens adequadas pode substituir a vulvectomia. A linfadenectomia inguino-femoral eletiva ainda é o procedimento padrão para estadiamento linfonodal. Pesquisa do linfonodo sentinela é factível e deve ser realizada por equipe multidisciplinar com experiência no método.

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Section: Discussionmentioning

confidence: 98%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Vulvar melanoma: report on eleven cases and review of the literature

et al. 2010

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“…Presentation as solitary organ tumors has also been reported. Diagnosis of the metastatic ovarian melanomas is difficult, especially if the primary lesion is not prominent (1)(2)(3). The reported case is a bilateral amelanotic metastatic ovarian melanoma presenting as a primary ovarian tumor with no obvious primary site.…”

Section: Introductionmentioning

confidence: 99%

Metastatic ovarian malignant melanoma with no obvious primary

Karateke¹,

Tuğ²,

Şahin³

2011

J Turkish German Gynecol Assoc

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The differential diagnosis of metastatic ovarian malignant melanoma from primary ovarian tumors is a significant challenge, particularly if there is no obvious primary site. A 39-year-old patient with bilateral ovarian malignant melanoma presented as stage IV primary ovarian tumor, with metastases in the omentum and spleen. She underwent a total abdominal hysterectomy and bilateral salpingo-oopherectomy with infracolic omentectomy and splenectomy. The diagnosis on examination of frozen sections was inconclusive. The final diagnosis was made by immunohistochemistry. The sections showed positive staining with HMB-45, vimentin, S-100, and no staining for cytoceratin, inhibin, calretinin and caldesmon. After the operation, the MRI at the 14 th postoperative day revealed metastatic lesions in the vertebrae, sacrum, bilateral humerus and femur and in the cerebral cortex, together with edema and hemorrhagic foci. The patient stayed in the intensive care unit for 12 weeks until her death due to cardio-respiratory arrest. This case highlights the clinical fact that metastatic malignant melanoma may mimic primary ovarian tumor with an occult or regressed primary. Both the standard pre-operative imaging modalities (such as CT, MRI) and the histo-pathologic examination of the frozen sections may be inconclusive in the differentiation of ovarian melanoma from epithelial ovarian malignancies. The final diagnosis could be established by immunohistochemistry. Intra-abdominal debulking surgery would not prolong the survival of metastatic ovarian melanoma because of the occult or rapid metastasis to the extra abdominal sites of the tumor. (J Turkish-German Gynecol Assoc 2011; 12: 181-2) Key words: Melanoma, ovary, metastatic melanoma, amelanotic melanoma Received: 26 July, 2010 Accepted: 5 September, 2010Metastatik overyan malign melanomun primer over tümörlerinden ayırt edilmesi, özellikle primer odağın belli olmadığı olgularda oldukça zordur. 39 yaşında bilateral overyan malign melanomu olan hasta, dalak ve omentumda metastazları mevcut evre IV primer over tümörü olarak prezente olmuştur. Hastaya total abdominal histerektomi, bilateral salpingo-ooferektomi, infrakolik omentektomi ve splenektomi yapılmıştır. Frozen seksiyonda tanı şüpheli olup kesin tanı immüno-histokimyasal boyama sonrası konulabilmiştir. Kesitlerde HMB-45, vimentin ve S-100 müsbet, sitokeratin, inhibin, kalretinin ve kaldezmon menfi boyanma göstermiştir. Post-operatif 14. günde yapılan MRI incelemesinde vertebra, sakrum, bilateral humerus ve femur ve serebral korteksde metastatik lezyonlar, ödem ve hemorajik lezyonlar saptanmıştır. Hasta 12 hafta boyunca, burada kalp-solunum yetmezliği sonucu hayatını kaybedinceye kadar yoğunbakım ünitesinde kalmıştır. Bu olgu, primer odağı gizli yada regrese olmuş metastatik malign melanomun primer over tümörlerini taklit edebileceğini vurgulamaktadır. Hem tomografi ve MRI gibi standart pre-operatif görüntüleme yöntemleri, hemde frozen seksiyon incelemesi overyan melanomun epitelyal over malignensilerinden ayırt edilmesi...

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“…Ariel et al (31) in 1981 stated that malignant melanoma of the female genital tract comprises 3% of all melanomas afflicting females. The authors had treated 45 patients with melanoma of the vulva which was most common form.…”

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confidence: 99%